Cycling Cross-Country: T1D and Tubeless

12/5/17

WRITTEN BY: Abbey Brau

No, I don’t mean my tires. I mean my insulin pump.

During the summer of 2017, I joined Team Bike Beyond to raise awareness of Type 1 diabetes and destroy stereotypes by cycling across America — New York to San Francisco. The Bike Beyond team was organized by Beyond Type 1 and included 20 cyclists who all live with Type 1 diabetes. The team included amazing humans from around the world who came together to prove that you can do anything with T1D and you can manage T1D on your own terms. This team ranged in age from 17 to 53, had T1D experience from 18 months to 29 years and used a wide variety of management techniques from CGM to MDI to pumps to no CGM. While we were out there to educate others, we were also educating each other. I will be forever grateful for all the wonderful information I gained from my fellow teammates.

My personal brand of T1D management currently includes a pump and a CGM. I wear an Omnipod insulin pump and use the Dexcom continuous glucose monitor. If you’re not familiar with the Omnipod, it’s essentially “tubeless.” I mean … technically there is a little tube/cannula that goes under the skin and delivers insulin, but for all intents and purposes, the system is tubeless. The “Pod” that holds the insulin reservoir is disposable after 72 hours and is controlled by a wireless PDM (personal diabetes manager). It has an adhesive backing that allows you to stick it anywhere you would inject insulin. The cannula ejects itself from the pod, into your skin, when you have filled it with insulin and hit “start” on the PDM. Thus, no long tubing, no infusion sets, no figuring out where to clip your “pager.”

After diagnosis, I spent my first four years managing T1D via MDI — Multiple Daily Injections — and was not using a CGM. I made the decision to go full robot parts based on a lot of personal research (actually just reading blogs) and a desire to have more precise control over my insulin needs. My background is in long-distance, open-water swimming and as I was lengthening the distances I was swimming, I wanted to have the ability to adjust my insulin needs specifically for different types and durations of workouts. Ultimately I selected the Omnipod based on the fact that it was waterproof (no need to “un-plug”) and, since I could basically wear it anywhere, I wouldn’t need to clip it on my swimsuit or worry about it during a flip-turn. I added the Dexcom a few months later because I had hit my health insurance out-of-pocket max (#realtalk) and I wanted to have more data around what was happening to my blood sugar during different workouts.

So, what was it like cycling across the country, Pod on fleek? I’m pretttttty much obsessed with these little guys. I’ve been using Pods for a little over three years now and they’ve been great from a swimming standpoint, but until the ride this summer, I hadn’t done a TON of cycling while using them. So I wasn’t exactly sure what to expect. But here’s the thing, I fell more in love with them than I was before. And, don’t get me wrong, it wasn’t ALLLL sunshine and unicorns.

I mostly wore Pods on my lower back/love handles (oh yeah, this cyclist has love handles). This area is my fave for being active because it means the Pod will probably be covered by my swimsuit, yoga pants, OR of course, BIKE SHORTS. Other Podders on the team used their leg or back of their arm fairly often. To this day, I’ve only put a Pod on my leg one time. Ever. It was during the ride. Peer pressure from other Podders that loved that location. It was alright. You do you.

Going tubeless means you don’t have to worry about using one of the pockets on your bike jersey to hold your pump, or clipping it to your shorts. Or worry about getting the tubing caught on your bike or hydration pack.

It also means that, if needed, I can change my pump anywhere, anytime. No, I haven’t mastered a pod change WHILE riding my bike (probably don’t try this at home), but I have swapped out a new pod on the side of the road in Nevada, halfway up Lookout Mountain in Colorado and on top of a hay bale in Kansas — amongst other unique backdrops for the changing of a medical device.

Now, if the rest of my team is reading this, they’re probably like — “Yeah, yeah … we GET IT. You’re into the Omnipod … but remember the ‘BLEEDER’?? Remember when you put a new pod on only to have it fall off hours later?” — Fair. While they actually probably wouldn’t say this exactly (because who remembers the pump issues of someone else?!), I would be remiss not to mention the few times I had with Pod errors or adhesive that wasn’t “adhesiving.” Because in the real world, when you’re biking across the desert in August, you get sweaty and you wear sunscreen and you ask that pump to work in severe conditions it doesn’t see every day.

While the main reason I’ve changed pods in such interesting locations is because I like to get every.last.drop. out of the Pod before I change it, and occasionally the Pod would error out or detect an occlusion unexpectedly (I can actually hear you sighing in agreement, Other Pod Users). Usually a roadside change meant I would be putting the Pod on my arm, and let me tell you … all the alcohol swabs in the world can’t clean off the layer of sunscreen/sweat/dirt covering your limbs after a short ride through a windy Utah canyon. The adhesive on an Omnipod is probably not tested to withstand a cross-country bike trek and would often mean a Pod replaced mid-ride, and located on my arm, would fall off by evening. OR I’d have an arm full of RockTape in an effort to keep the cannula stuck in my arm for another 48 hours. It’s a cute look. 😉

All in all, cycling cross-country tubeless worked out great for me and I’d definitely do it again. Then again, I would cycle across the country again tube-less or tube-full or T1D or no-T1D (is that an option?!). The coolest part of this story is not that I used an Omnipod to cycle across the country with Type 1 diabetes, or that my teammates used their own means of T1D management … it’s that a team of 20 cyclists, all living with Type 1 diabetes cycled across the country. And the fact that I’m not just writing an article about the idea of that, but sharing logistics and details about pump-use during the ride so you know adventures like this are totally accessible to anyone with T1D. HOW COOL is that?

PS — I still vote tubeless. Insulin pump, not tires. We carried around enough extra tire tubes this summer … I didn’t need to add pump tubing to that gear list as well. 😉

Abbey Brau

As a self-proclaimed life-enthusiast and a marathon swimmer, Abbey isn't into letting T1D be the reason she can't accomplish a goal or say YES to new adventures. She has swam around the island of Manhattan and most recently biked from New York to San Francisco as a Team Leader for Team Bike Beyond. She was diagnosed with Type 1 diabetes on April 14, 2010 — 98 years to the day of the Titanic sinking — #funfact. Abbey lives in Minnesota and you can follow her adventures on Instagram at @ambrau.